Inspection·July 17, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some others in the last 1 to 3 days. His active diagnoses included epilepsy (a neurological condition characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain) and transient cerebral ischemic attack (a stroke, which happens when something prevents your brain from getting enough blood flow).Record review of Resident #3's care plan reflected the following: Focus: Resident will be observed by staff for 1:1 monitoring.Interventions: Resident will be observed by staff at all times during 1:1 monitoring. Date Initiated: 05/23/25. Focus: Behavior: Sexually inappropriate AEB: Making unwanted advances towards other residents.Interventions: Evaluate the resident's ability to understand behavior and the consequences of that behavior. Explain to resident the acceptable expressions of sexuality based on the cognitive evaluation. Listen/talk to the resident- see if they will tell you why they do the behavior. Psychiatric Services consult as needed. Reinforce with staff that clear, firm limits are healthy and required when resident makes inappropriate gestures or statements. Report incidents of inappropriate sexual behavior to charge nurse. If other resident's are involved, immediately intervene to protect the safety of all residents involved. Staff to be inserviced [sic] on behavioral approaches designed to effectively manage unacceptable sexual advances (avoid self disclosing personal information).Record review of Resident #3's Progress Notes reflected the following:-RN F on 05/23/25 at 11:57 AM wrote: Staff reports coming into building from lunch, witness this resident standing behind couch reaching for another resident who was sitting on couch and kissing on her face. This resident was attempting to lift other resident's head up by the chin to kiss her on the lips. When this resident noticed staff member he stopped and walked away from female resident. Female resident removed from area, one on one started with this resident. Resident Statement: ‘I was just kissing her, she didn't sayno' [sic].-the SW on 05/23/25 at 2:03 PM wrote: Social worker called and notified resident's responsible party of immediate discharge due to inappropriate sexual behavior.Record review of a witness statement, dated 05/23/25, and signed by Housekeeper E reflected the following: I, [Housekeeper E], was walking through the lobby when I saw [Resident #3] leaning over the back of the couch with his arms around [Resident #1]. [Resident #3] was trying to lift [Resident #1's] head up. [Resident #3] was kissing on [Resident #1's] face through out trying to get [Resident #1's] head up. As soon as [Resident #3] saw me, he stopped what he was doing and walked off.Record review of Resident #3's Facility Initiated Discharge Protocol document reflected the following: 1. What are the specific resident needs the facility cannot meet? Resident has been sexually abusive to female that was not consensual. This type of behavior puts all nonconcentual [sic] residents at harm for sexual assault.Interview on 07/17/25 at 1:00 PM with Resident #1 revealed she felt safe in the facility, and no one had ever tried to kiss her, which included Resident #3.Interview on 07/17/25 at 11:43 AM with CNA B revealed she never saw or cared for Resident #3, but she never heard about him having any sexual behaviors towards anyone. CNA B said she had been in-serviced regarding abuse/neglect and residents who had sexual behaviors. Interview on 07/17/25 at 11:49 AM with LVN A revealed she never saw or cared for Resident #3, but she never heard about him having any sexual behaviors towards anyone. LVN A said she was in-serviced regarding abuse/neglect and residents who had sexual behaviors.Interview on 07/17/25 at 12:03 PM with CNA C revealed she never saw or cared for Resident #3 but she never heard about him having any sexual behaviors towards anyone. CNA C said she had been in-serviced regarding abuse/neglect and residents who had sexual behaviors.Interview on 07/17/25 at 12:16 PM with LVN D revealed she never saw or cared for Resident #3 but she never heard about him having any sexual behaviors towards anyone. LVN D said she had been in-serviced regarding abuse/neglect and residents who had sexual behaviors. Attempted phone interview on 07/17/25 at 1:20 PM with Housekeeper E was unsuccessful as she did not answer or call back prior to exit. Interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676004 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hills Nursing & Rehabilitation 201 E Thompson St Decatur, TX 76234 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on 07/17/25 at 1:44 PM with the ADON revealed Residents #1 and #3 were friendly with each other that he knew of, sitting at the dining room table together during meals. The ADON said staff reported Resident #3 had kissed Resident #1 but she did not want him to do that to her. The ADON said Resident #1 seemed only upset that she would be in trouble if people found out Resident #3 kissed her. The ADON said Resident #3 was placed on 1:1 monitoring until he was discharged later that day. The ADON said Resident #3 did not have any sexual behaviors prior to this incident, that staff were aware of. The ADON said staff were in-serviced regarding abuse and neglect and residents who had sexual behaviors.Interview on 07/17/25 at 3:32 PM with the DON revealed from what she heard, Resident #1 was sitting down on the sofa in a common area with her head down. The DON said Resident #3 was behind the couch and pulling Resident #1's chin up to him so he could kiss all over her face. The DON said the facility separated the two residents immediately and placed Resident #3 on 1:1 monitoring until he left the facility. The DON said the facility also contacted the local police department to file a report about what happened. The DON said Resident #3 was issued an immediate discharge due to his behavior. The DON said Resident #3 never showed any sexual behaviors prior to this incident. The DON said the incident was considered sexual abuse because Resident #1 told him no and Resident #3 continued to try kissing her. The DON said all residents had the right to be free from abuse since they were vulnerable adults. The DON said all staff were responsible for ensuring residents were free from abuse. The DON said residents could suffer emotional damage or physical damage if they were not free from abuse. The DON said staff had to monitor residents to make sure no abuse occurred. The DON said staff were trained to identify and prevent abuse towards residents.Record review of a witness statement, dated 05/23/25, and signed by the DON reflected the following: On May 23, 2025, at approx. 1205 pm [sic] I [the DON] interviewed [Resident #1] about the event that was witnessed by staff in the lobby. [Resident #1] told me that [Resident #3] started kissing her and she told him to stop but he wouldn't, he kissed her face and was trying to kiss her on the mouth. [Resident #1] stated, ‘I told him to stop because we were going to get into trouble'. [sic] Later [Resident #1] was in my office with her [family member], and once again she told me ‘I told him to stop, but he didn't. [Resident #1's family member] stated she told [them] that during her doctor's appointment yesterday [Resident #1] told [them], ‘I think I have a problem, a guy keeps kissing me'. [sic] [Resident #1's family member] stated he had planned to come to the facility today to talk to use about the comment. During the Secure Care Consult assessment, when asked has anything negative or positive happened to you, [Resident #1] stated, ‘Yes negative' ‘Advancement from a guy I wasn't found of' [sic] when asked who the guy was, she stated ‘[Resident #3]'.Record review of a provider investigation report reflected the following: Description of the Allegation: Resident sitting on sofa in lobby with another resident behind her. Male resident was kissing all over resident's face and resident was holding her head down while male resident was attempting to raise resident's face by placing his hand under her chin.Investigation Summary: [Resident #3] was discharged . [Resident #1] remains in positive spirits with not [sic] emotional distress. Record review of the facility's Resident to Resident Sexual Behavior Monitoring Sheets reflected residents were asked if there were any inappropriate or sexual behaviors identified amongst each other from 05/26/25 to 07/17/25. Record review of an in-service dated 05/23/25, and titled Abuse/Neglect Policy and Trauma Informed Care reflected 23 staff had been in-serviced.Record review of an untitled piece of paper, dated 05/23/25, reflected an Ad Hoc QAPI Meeting was held regarding the incident between Residents #1 and #3.Record review of 23 Staff Safety Surveys reflected staff had not seen Resident #3 have any inappropriate or unwanted behaviors towards Resident #1.Record review of 55 Resident Safety Surveys reflected none of the residents reported being abused at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676004 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hills Nursing & Rehabilitation 201 E Thompson St Decatur, TX 76234 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility. Record review of untitled pieces of paper reflected Quality of Life rounds were completed from 05/26/25 to 07/11/25 with no findings.3. Record review of Resident #2's annual MDS, dated [DATE], reflected the resident was a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease, anxiety disorder, and depression. Resident #2 had a BIMS of 14, which indicated her cognition was intact. Record review of Resident #2's care plan revised on 03/19/25 reflected the resident had shortness of breath related to anxiety. Interventions reflected monitor/document changes in orientation, increased restlessness, anxiety, and air hunger. The resident's care plan further reflected she had a history of making false accusations towards the staff and making phone calls to the family late at night stating she could not breathe, and nobody would help her. Interventions included to assist resident care in pairs and staff to offer encouragement and emotional support and administer medications as ordered. Record review of the facility's Provider Investigation Report, dated 06/06/25, reflected the following: During resident safe surveys Resident #4 stated he heard charge nurse [LVN G] tell Resident #2 to ‘shut the fuck up'.Resident assessed and skin assessment performed. Resident could not recall incident. Resident had no signs of physical or emotional distress.Observation and interview on 07/17/25 at 10:33 AM with Resident #2 revealed she was in bed with continuous oxygen running at 2 liters. The resident stated the staff treated her well and were nice to her, and denied being yelled at or cursed at by LVN G. Resident #2 immediately began to say she could not breathe and wanted a nurse in the room. The charge nurse arrived shortly and took her vitals which were within normal limits but kept stating she knew she would die soon as the nurse stay and attempted to comfort the resident. Interview on 07/17/25 at 10:24 AM with Resident #5 revealed one night, did not recall the date, Resident #2 kept repeating she could not breathe and LVN G said you need to shut up cause you wouldn't be talking if you couldn't breathe and the resident continued to say she could not breathe. Resident #5 was asked if she overheard LVN G tell Resident #2 to shut the fuck up and Resident #5 said she didn't say those words but that was basically what she meant.Interview on 07/17/25 at 11:51 AM with LVN H revealed Resident #2 had increased anxiety and continuously said she could not breathe, and the nursing staff would enter her room to assess her and try to calm her down. LVN H said when Resident #2 was yelling she could not breathe she would yell out stating she needed her breathing pill. Interview on 07/17/25 at 12:17 PM with LVN I revealed Resident #2 had increased anxiety and would always say she could not breathe, and it appeared these statements were getting steadily worse. LVN I stated the resident did not want staff to leave her room and when they would Resident #2 would become very anxious and work herself up and begin to say she could not breathe. LVN I further stated they tried to increase her anxiety medications, but it made her drowsy and a high fall risk, so they had to lower the medication. LVN I said there were only certain nurses Resident #2 preferred to care for her but did not state which ones. Interview on 07/17/25 with the ADON revealed Resident #2 continuously stated she could not breathe, and it appeared her anxiety was getting worse, so staff often tried to comfort or calm her down. The ADON said he spoke with Resident #2, and she mentioned there was a nurse who appeared to have a bad day/attitude who spoke to her rudely, but did not say how, but he did not recall the resident saying she had been told to shut up. The ADON stated Resident #2 identified that charge nurse as being LVN G, but the resident did not appear to be in distress or have any lasting effects from the incident. The ADON further stated LVN G wore hearing aids therefore spoke loudly in, but he had never noticed or had any complaints regarding LVN G being rude or verbally abusive.Interview on 07/17/25 at 2:09 PM with Resident #4 revealed one night, did not recall the date, he overheard LVN G tell Resident #2 she did not have all damn night to stay in her room and she just needed to take her damn medicine because she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676004 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hills Nursing & Rehabilitation 201 E Thompson St Decatur, TX 76234 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete was not going to return to the room. Resident #4 was asked if LVN G told Resident #2 to shut the fuck up and Resident #2 said she might have.Interview on 07/17/25 at 2:43 PM with CNA J revealed Resident #2 had an obsession saying she could not breathe due to her increased anxiety and when the nurse would check her oxygen levels, there were within normal limits. CNA J said LVN G could not hear well so therefore spoke loudly, but she never saw or heard LVN G be rude or yell at any residents nor did anyone complain about her. Interview on 07/17/25 at 3:12 PM with the DON revealed Resident #2 had increased anxiety and frequently repeated she could not breathe, and it appeared to get worse after a recent hospital stay. The DON said the nurses would often check her oxygen levels and find them within normal limits. The DON further stated they were doing safe surveys on all the residents when Residents #3 and #4 both said they had heard LVN G raise her voice at Resident #2, but she did not recall all the details because the Interim Administrator had conducted the investigation. Interview on 07/17/25 at 3:51 PM with the Interim Administrator revealed staff were conducting safe surveys on the residents when they were told by Resident #4 and #5 there was a night nurse that was heard yelling at night, especially directed to Resident #2 when she was told to shut the fuck up. The Interim Administrator said she followed up with Resident #2 and she had described the night nurse, and they concluded it was LVN G based on the resident's description. The Interim Administrator said Resident #2 did not give her specifics on what LVN G said to her but only said the nurse would get loud with her and yell and did not like to give her medications. The Interim Administrator further stated Resident #2 did not appear to be upset or in distress but because there had been two other residents with similar stories, LVN G was terminated. Attempts to interview LVN G via telephone on 07/17/25 were unsuccessful. Record review of LVN G's Employee Disciplinary Report, dated 06/03/25, reflected: LVN G wrote, I did not say what I am accused of saying. I will not sign this form! Corrective Plan of Action.[LVN G] will be terminated effective immediately.Staff of all disciplines and from various shifts were inserviced on abuse/neglect and customer service/bedside manor on 06/03/25. Record review of the facility's current, undated Abuse/Neglect policy reflected: The resident has the right to be free from abuse.Residents should not be subjected to abuse by anyone, including but not limited to, facility staff, other residents.The facility will provide and ensure the promotion and protection of resident rights. Event ID: Facility ID: 676004 If continuation sheet Page 5 of 5